Multiple Synchronous CSF-Venous Fistulas in Spontaneous Intracranial Hypotension: A Multi-Institutional Case Series
Bibliographic record
Abstract
ABSTRACT CSF-venous fistulas are a common cause of spontaneous intracranial hypotension. Due to the more routine use of decubitus myelography and advancements in various imaging techniques, recognition of CSF-venous fistulas has increased in recent years. Most commonly, patients harbor only one fistula at the time of myelography (although additional de novo fistulas can arise after treatment). Occasionally, two synchronous CSF-venous fistulas may be seen on a single myelogram. The co-existence of more than two CSF-venous fistulas, however, is quite rare and has only been previously described in two instances. Here, we present a multi-institutional series of sixteen patients with three or more concurrently discovered CSF-venous fistulas, representing the largest cohort of such patients to date. We describe their clinical features, imaging findings, treatment approaches, and outcomes. ABBREVIATIONS: CVF = CSF-venous fistula; CB-CTM = cone beam CT myelogram; DSM = digital subtraction myelography; EID = energy integrating detector; SIH = spontaneous intracranial hypotension; PCD = photon counting detector
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".